Elbow tendonitis long-term management.

[i.munro]

physio shows some benefits initially but at 52 week follow-up there is no difference when compared to watch and wait policy

In fairness, I would expect any injury, that physio could address, to heal if I stopped aggravating it for 52 weeks!
What I hope to get from a physio is the ability to get back to climbing faster & (hopefully) a reduced chance of re-occurrence.

The other thing I note is that there seems to be a theme of shoulder instability running through the answers on this thread.
My physio diagnosed the same root cause & I've noticed that a lot of the so-called antagonist exercises that people recommend overlap to some extent with the exercises I've been given to try & address this.
For example the last few cm at the top of a press-up is the same as one of the exercises I've been given  for the serratus anterior. Is it possible that the reputation (among climbers) of the injury-proofing effect of antagonist training is this incidental strengthening of the shoulder stabilisers (when donne with the correct form)?

[tim palmer]

physio shows some benefits initially but at 52 week follow-up there is no difference when compared to watch and wait policy

In fairness, I would expect any injury, that physio could address, to heal if I stopped aggravating it for 52 weeks!
What I hope to get from a physio is the ability to get back to climbing faster & (hopefully) a reduced chance of re-occurrence.

I think you might have got the wrong end of the stick, the follow-up was at one year, not the duration of watchful waiting.  What i meant was, in the longterm physio is no better than being sensible for a similar duration.

[Stubbs]

Is it possible that the reputation (among climbers) of the injury-proofing effect of antagonist training is this incidental strengthening of the shoulder stabilisers (when donne with the correct form)?

I don't know any climbers that do 'antagonistic' exercises, but I know a lot who do theraband rotator cuff exercises.
I think the 'reputation' of any 'antagonist' exercises stems from misguided folks that think doing 50 pressups a day is going to save them from tendonitis.

[Johnny Brown]

I seem to remember Wobble telling me about going to The Forest with Team-shy-yorkshire-8b and them all doing press-ups every night to prevent font elbow. And who'd argue with them! Hopefully he'll correct me if I'm wrong.

As long as I do Yoga most weeks it seems to keep my shoulder instability under control. I've never had elbow problems up until this year, which I put down to going to font in Oct before I'd got the body back into bouldering.

[Stubbs]

It'd be interesting to know if any of the more waif-like members of the board have ever suffered from elbow issues: Paul, Sausage, Dense etc? I reckon Wobble and to a slightly lesser extent Messrs Clifford and Birch of of a body type which will be less susceptible to elbow problems in the first place.

[Johnny Brown]

Not likely after all those press-ups!

[dobbin]

It'd be interesting to know if any of the more waif-like members of the board .... Dense

hAHAHAHAHHAHAHAHHAHAH! Dense - waif like! brrrrilliant! i love you  stubbs.

[Falling Down]

I've been suffering with Tennis Elbow since August. Had 15 or so Physio sessions that got rid of a load of scar tissue and seemed to alleviate the symptoms but I keep getting the odd random day when it seems to be back again like on Saturday when I was doing some work on our fireplace when I was using a hammer and lifting stuff.  Sunday it was sore again.... 

I'm doing the stretches and keeping my back and shoulders as supple as possible and not doing much climbing indoors until I've had a good stint outside and see how it feels.

[i.munro]

I think the 'reputation' of any 'antagonist' exercises stems from misguided folks that think doing 50 pressups a day is going to save them from tendonitis.

It's certainly something I get told a lot.
My question was whether the effect on the shoulder stabilisers means that ,like a lot of myths, there's a little bit of truth buried in there.

[highrepute]

It'd be interesting to know if any of the more waif-like members of the board have ever suffered from elbow issues: Paul, Sausage, Dense etc? I reckon Wobble and to a slightly lesser extent Messrs Clifford and Birch of of a body type which will be less susceptible to elbow problems in the first place.

I think I'm about as waifer-thin as they come <9st and I've had elbow problems.

[TMR]

i had serious issues with elbow tendonitis around a year ago (pain radiating up from elbow to shoulder),, at the time i just used to concentrate on routes, but more than two days in a row bouldering would always bring it back (font and grit being the worst aggravators). i read an article and spoke to some physio friends who claimed that all the repetive pronated (palm away) actions involved in climbing lead to imbalances. while sitting out a month with a tweaked finger i did lots of supinated (palms up) exercises, biceps curls, writs curls and pull-ups. after the month off i took another month to slowly ease back into things, avoiding consecutive days climbing and throwing myself at compression-style bouldering. ive just come back from a 3 month trip to the states involving 5 days a weeks climbing and only suffered a very mild case on my fourth consecutive day at bishop, which a days rest sorted. that is the only time i have felt anything amiss in the last six months. my diagnosis is that some rest, supinated exercises and a gentle return gave my tendons time to catch up strength wise with my muscles (i could of course be chatting shit, as i have no medical training). fingers crossed for the future.....

[stone]

I'm a fan of "turkish get ups" as a shoulder fixer/ elbow protector exercise.  5mins twice a week seemed enough to help which made it more likely for me to get them done. My impression was that they are ideal for getting the shoulder to work less dysfunctionally and that helps the elbows too.

[Paul B]

It'd be interesting to know if any of the more waif-like members of the board have ever suffered from elbow issues: Paul, Sausage, Dense etc? I reckon Wobble and to a slightly lesser extent Messrs Clifford and Birch of of a body type which will be less susceptible to elbow problems in the first place.

I think I'm about as waifer-thin as they come <9st and I've had elbow problems.
[/quote]

Sorry I hadn't looked in this thread. Basically because I've never had any trouble 
ps - I'm skinnier than him I bet.

[Skinny Pete]

I'm a fan of "turkish get ups" .....

Excuse my ignorance, but what is a "turkish get up"?  I'm guessing it doesn't involve growing a hefty 'tache and wearing a fez and embroidered waistcoat?

PS: Is that Stone the Glossop-dwelling beast?  If so, is that Ford Ka you bought off me still going, or did it explode after one too many thrashings over the Snake Pass?

[The Sausage]

Stone, thrashing it over the Snake?!
He's a self-confessed Granny driver. That Ka will go forever, although it may never hit 3rd gear...

[dave]

It'd be interesting to know if any of the more waif-like members of the board have ever suffered from elbow issues: Paul, Sausage, Dense etc?

I'm not a waif but have had elbow shit in the past. I do some theraband and pressups every day to keep it in check, have done so for maybe the last 8 years. only really comes back if i get lazy and forget for some reason.

[fried]

Thanks Sausage for suggesting the shoulder as being the root of my problems. I've been 'banding 30mins per day + press-ups and my whole arms and shoulders feel less 'twangy' and less subject to random aches and pains for no apparent reason. I haven't pushed the climbing too much, but hopefully if the sun ever makes an appearance I'll find out if this is going to be a permanent solution.

[Richie Crouch]

Theraband and pressups before and after climbing as part of a warmup and warmdown (and also on rest days) have helped massively in the last year. Avoiding intensive campussing for more than a couple of weeks at a time has been another reason for less inner elbow pains.

[Scraggadoo]

I have to say that doing press ups almost every day has helped significantly reduce the pain I get in my inner elbows sometimes when I climb.

I have thought of swimming as one possible way to reduce the chances of this happening. You use your shoulder in quite a lot of its motion in say front crawl or even backstroke with constant resistance through its range of motion in whatever stroke you do. Haven't actually tried it out though but would be good to see if anyone has tried this or if my reasoning is flawed. The sausage seems well informed on these matters so would be good to hear what he reckons to this as well...

Edit: My reasoning is that swimming would help to strengthen the weak areas of the shoulders supposing that this is the root cause of elbow tendonitis

[sidewinder]

Been following this thread with interest, started to get problems with my left elbow after restarting climbing after a long lay off.  As I have a trip coming up soonish I decided to seek some advice and saw John Ostrovskis who works at the place round the corner from The Works.  He diagnosed medial (golfers) elbow as I suspected.
The treatment, cold water twice a day ~20mins, wrist curls as described by the Athlon article , wide armed press-ups with a shrug and a couple of sessions of him working on my very tight shoulder as well as some massage on my elbow tendon and acupuncture (no personal opinion on this but it I have got better fast so am not complaining).

This has worked very well!  I have now switched from cold water treatments to massaging the tendon twice a day (as recommended). I am still having to take it easy on the bouldering front but am able to do stamina type work pain free and apparently without aggravating it.  Interesting from this thread that peoples elbow problems almost always seems to be related to the shoulder.  Since it has been pointed out to me I now realise how tight my shoulder is after a climb, I am hoping that as I continue with the press ups this stops being an issue.

[Rocksteady]

I've been reading this thread with interest as I'm starting to get a sore point on the outside/top of my elbow (lateral epicondriwhatyoumacallit?) which is starting to worry me. I've been doing a lot more bouldering than I used to, and it seems to have brought it on.

What do we know about what causes these elbow problems? From the above shoulder instability is ascribed as a cause, but what style of climbing/specific movement pattern results in the elbow problems?

Is it repeatedly cranking in with the arms, rather than climbing straight armed? Is it shock-loading the elbows with dynamic moves at extension? Or is it a more insidious thing based on individuals' posture/movement style etc?

I guess what I'm getting at is that there are a lot of people who crank hard regularly who don't seem to get injured. What are they doing right that others are not?

[Bernard Jefferies]

It's just that you're cranking hard mate.  Your elbows are dealing with increased load as you climbing harder boulder problems.  It will just be a case of letting your elbows catch up with your climbing I'm afraid.

[sidewinder]

I was told that the problem is that if your shoulder is not working right, it is not helping your elbow as much as it should when you climb, thus more load goes through your elbow leading to the tendonitis.  I imagine the people who crank hard regularly without injury have shoulders that have naturally co-operated.  My physio also said that often these problems often happen if you suddenly increase the volume of your climbing (in particular strength/power work) as the elbow often responds faster than the shoulder leading to an imbalance and then tendonitis.

[Rocksteady]

Want to improve = climb more.

Climb more = elbows and shoulders get out of balance, need to climb less to let 'elbows catch up with climbing'?

Climb less = stay at same level.

Solution = immense patience?!!?

I'm not a mathematician but that is some depressing shit!

[sidewinder]

Climb more = elbows and shoulders get out of balance, need to climb less to let 'elbows catch up with climbing'?

Or climb more and incorporate some of these antagonistic type exercises, push ups, wrist curls etc to help your body adapt to the increased load.